In July 2017, McCain made a dramatic entrance onto the Senate floor and gave a thumbs-down to the GOP bill under consideration.
The plan was to pass it, and in a House-Senate conference, get closer to a bill to repeal the law.
But McCain's "no" vote made the bill fail 49-51 in the Senate (a tie would have been broken by Vice President Pence in favor of the GOP).
On Tuesday morning, Ryan, R-Wis., made it clear the party was still smarting over McCain's surprise vote.
"Unfortunately, somebody did this instead of that in the Senate, and it didn't pass," Ryan said, giving a thumbs down and then a thumbs up.